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Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China.

This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs.

Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs.

The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

Purpose – To estimate the impact of diabetic drug adherence on hospitalizations, emergency room (ER) visits, and hospital costs.

Methods – It is often difficult to measure the impact of drug adherence on hospitalizations since both adherence and hospitalizations may be correlated with unobservable patient severity. We control for such unobservables using propensity score methods and instrumental variables for adherence such as drug coinsurance levels and direct-to-consumer advertising.

Findings – We find a significant bias due to unobservable severity in that patients with more severe health are more apt to comply with medications. Thus, the relationship between adherence and hospitalization will be underestimated if one does not control for unobservable severity. Overall, we find that increasing diabetic drug adherence from 50% to 100% reduces the hospitalization rate by 23.3% from 15% to 11.5%. ER visits reduce by 46.2% from 17.3% to 9.3%. Although such an increase in adherence increases diabetic drug spending by $776 a year per diabetic, the cost savings for averted hospitalizations and ER visits are $886 per diabetic, a cost offset of $1.14 per $1.00 spent on diabetic drugs.

Originality – Most of the drug cost-offset literature focuses only on the impact of cost-sharing and drug spending on cost-offsets, making it impossible to back-out the empirical impact of actual drug adherence on cost-offsets. In this chapter, we estimate the direct impact of adherence on hospitalizations and costs.

This study aimed to compare mortality rate, length of stay (LOS) and hospitalization costs at different priority levels for a patient admitted to an intensive care unit (ICU) at a public tertiary hospital in Qazvin, Iran. This study also aimed to predict influencing factors on patients’ mortality, ICU LOS and hospitalization costs in different admission groups.

The authors conducted a retrospective cohort study among patients who mainly suffered from internal diseases admitted to an ICU of a public hospital. This study was conducted among 127 patients admitted to ICU from July to September 2019. The authors categorized patients into four groups based on two crucial hemodynamic and respiratory status criteria. The authors used a logistic regression model to predict the likelihood of mortality in ICU admitted patients during hospitalizations for the four prioritization groups. Furthermore, the authors conducted a multivariate analysis using the “enter” method to identify risk factors for LOS.

Results showed a statistically significant relationship between the priority of being admitted to ICU and hospitalization costs. The authors’ findings revealed that age, LOS and levels of consciousness had a predictability role in determining in-hospital mortality. Besides, age, gender, consciousness level of patients and type of the disease were mentioned as affecting factors of LOS.

This study’s findings emphasize the necessity of categorizing patients according to specific criteria to efficiently use available resources to help health-care authorities reduce the costs and allocate the budget to different health sectors.

Costs estimation is essential and important to resource allocation and prioritizing different interventions in the health system. The purpose of this paper is to estimate the costs of lung cancer in Iran, in 2017.

This was a prevalence-based cost of illness study with a bottom-up approach costing conducted from October 2016 to April 2017. The sample included 645 patients who referred to Imam Reza hospital, Tabriz, Iran, in 2017. Follow-up interviews were every two months. Hospitalization costs extracted from the patient’s record and outpatient costs, nondirect medical costs and indirect costs collected using questionnaire. SPSS software version 22 was used for the data analysis.

Mean direct medical costs, nondirect medical costs and indirect costs amounted to 36,637.02 ± 23,515.13 PPP (2016) (251,313,217.83 Rials), 2,025.25 ± 3,303.72 PPP (2016) (16,613,202.53 Rials) and 48,348.55 ± 34,371.84 PPP (2016) (396,599,494.56 Rials), respectively. There was a significant and negative correlation between direct medical costs, direct nonmedical costs, indirect costs and age at diagnosis, and there was a significant and positive correlation between the length of hospital stay and direct medical cost.

As the cost of lung cancer is substantial and there have been little studies in this area, the objective of this study is to investigate the cost of lung cancer and present ways to tackle this.

The purpose of this paper is to analyze the potentiality in the application of process analysis and activity‐based costing (ABC) in a healthcare setting to produce usable, useful and correct information on resource consumption and processes. The paper aims to analyze changes applied to the traditional costing model in order to represent the work flow of the organization and the related additional information usable by decision makers at different levels. In particular, the paper is focused on economic analysis related to the introduction of a new surgical technique in healthcare.

An empirical case study is developed in a Tuscan hospital from September 2005 to March 2006, data being collected through interviews to employees and direct observations.

Several factors are found to be critical in such a process analysis and in an ABC implementation in healthcare. First, the need to ground the development of the model structure on the specific characteristics of the organizational setting and the clinical work performed. Second, a problem of culture and language, because professionals have difficulties in understanding the language of activities, and they cannot accept a model designed to measure their work; therefore, some resistances may occur. Third, the constraint of information; in fact more precise estimation may be limited by the information available, as in this case.

The paper provides a framework for future research. The replication of the methodology in other hospitals, in order to test the validity of the model and to compare results, can be interesting and another can be the analysis of benefits that the application of the system can provide (in terms of improved efficiency) through a longitudinal analysis.

The paper contributes to the field study of ABC and process analysis in healthcare. The original contribution of the model lies in the classification of activities in a hierarchy across the organization, which allows a more precise identification of cost driver; and in the “hybrid” nature (a combination of cost centres and activities) of the model. The latter allows one to identify a “full cost” of the patient.

The population of New Zealand (NZ) is ageing; the proportion of people aged 65 and over as compared with the younger age groups is expected to increase from 15 per cent in 2016 to approximately 30 per cent by 2068. This change in demographics is bound to apply some pressure on economic resources due to factors such as superannuation and increased healthcare needs. The purpose of this paper is to explore the use of technology as being economically beneficial for managing the grey tsunami that has commenced in NZ. Though technology is still not being utilised to its full capacity in the healthcare sector, there is a reason enough to believe that it could be used in assisting with ageing in place. However, its cost-effectiveness has not been clearly demonstrated.

A literature search was performed using search engines such as ProQuest, EBSCO, CINAHL and Google Scholar. Keywords used were ageing in place, technology, assisted living technology, ageing, telecare and telehealth. The papers selected were publicly available. To determine if the cost evaluation literature were of acceptable quality, they were assessed according to a well-recognised economic evaluation checklist by Drummond et al. (2005).

As is evident from the demographic figures, there needs to be timely intervention to appropriately manage the ageing population given the projected financial and population figures. Technology has proved beneficial especially with positive ageing. A significant reason for it hardly being used is the lack of thorough studies that demonstrate its cost-effectiveness. The studies that have tackled the subject of economic evaluation have provided mixed results with some labelling technology as cost-effective and the others opposing this finding. Studies have shown that even the simplest form of technology such as a phone call, mobile health application or a pedometer can be effective.

The majority of research and funding is directed towards supporting the frail adults instead there should be equal focus on those who are reaching the old age group. Since current data suggest that people are living longer, early intervention is beneficial to reduce the number of years lived with disabilities along with associated costs of disease burden.

Healthcare policymakers need to take more proactive steps through incorporating technology rather than deferring its use until proven beneficial by large studies as this is not feasible given the rate at which technology is developing. Studies have shown that even the simplest form of technology such as a phone call, mobile health application or a pedometer can be effective.

Technology increases awareness and allows people to be more disciplined with their health plan which increases good health. Early intervention also means relying and involving the primary level of care to manage the disease which would be more economically beneficial than postponing care until the disease progresses in which case secondary or tertiary levels of care must be sought.

This is an emerging field in the area of aged care and only begins to expand potential horizons. Studies show that a significant number of the population prefer to stay in their own homes as they age and that with the improvement in technology this could become a reality. However, health planners need to be considering technology when developing health and social services.

The purpose of this study is to estimate the average cost of treatment and investigate the related parameters of HIV/AIDS among patients based on their annual treatment regime during the 2017 in Izmir.

The average annual direct cost of an HIV patient's treatment was estimated for 2017 at four university hospitals in a retrospective study in Izmir, Turkey. Inclusion criteria included confirmed HIV infection, age = 18 years, visited one of the hospitals at least three times a year and with at least one CD4+ T cell count. The average annual treatment cost per patient was calculated using accounting data for 527 patients from the hospitals' electronic databases.

The mean treatment cost per patient was US$4,381.93. Costs for treatment and care were statistically significantly higher (US$5,970.55) for patients with CD4+ T cell counts of fewer than 200 cells/mm³ than for other patients with CD4+ T cell counts above 200 cells/mm³. The mean treatment cost for patients who were 50 years old or older (US$4,904.24) was statistically significantly higher than for those younger than 50 years (US$4,216.10). The mean treatment cost for female patients (US$4,624.92) was higher than that of male patients ($US4,339.72), although the difference was not statistically significant. The main cost driver was antiretroviral treatment (US$3,852.38 per patient), accounting for almost 88% of all costs. However, the high burden of antiretroviral treatment cost is counterbalanced by relatively low care and hospitalization costs in Turkey.

The paper contributes to the literature by providing average annual treatment cost of an HIV-infected patient in Turkey by using a comprehensive bottom up approach. Moreover, cost drivers of HIV treatment are investigated.

Clinical pathways (CPs) are multidisciplinary care plans with essential care steps for patients with specific clinical problems. CPs were introduced in China in 2009 to assure quality, reduce risks, increase resource efficiency and control costs. The purpose of this paper is to present a Chinese public hospital case study where a CP pilot was undertaken to evaluate two main outcomes: length of stay and hospitalization costs for a tertiary hospital from 2010 to 2012 using a mixed-methods approach.

Data were drawn from hospital records and in-depth interviews with hospital staff in a Shanxi Province tertiary hospital, northern China.

The authors found that the main objectives: to standardize treatment procedures by reducing length of stay and containing costs, were not fully achieved. Staff implementing CPs clearly encountered several barriers; i.e., managers did not see the pilot as a useful managerial instrument but were still driven by revenue generation. Physicians, too, lacked incentive to follow the guidelines due to income concerns.

The authors point to the daunting challenges brought about by perverse incentives embedded in the country’s health system. The authors argue that concerted efforts are needed to undertake difficult health policy reforms in China.

The authors present the first empirical study in the English-language literature that examines China’s ongoing CP pilots from a micro perspective. The authors combine qualitative and quantitative methods and reveal the hospital-level dynamics in its implementation.

The purpose of this study is to identify the factors that were considered important by Muslim BPJS participants of service quality received when using BPJS Health card for hospitalization services.

The sample consisted of 250 respondents that came from five hospitals in Indonesia. The variables used in this study modify SERVQUAL, PAKSERV and CARTER models.

The results of this study indicate that there are ten factors that are considered very important by Muslim BPJS participants for hospitalization service, with the dominant variables of each factor being sincerity/sincerity of employees in serving BPJS participants, the amount of drugs cost borne by BPJS participants, cleanliness in the hospital building, tabligh attitude in serving BPJS participants (wise and right on target), reputation of BPJS doctors in the hospitals, affordability of the hospital location, compliance and accuracy of payment claim/treatment for BPJS patients, BPJS compliance with Islamic principles, the ability of BPJS to reliably deliver promised services and availability of mosque at BPJS referral hospital.

The new factors that have emerged are location access, information and availability of praying facilities. The sincerity and formality factors are considered very important by the Muslim community when using BPJS Health card for hospitalization service.

This study aims to provide insights into management accounting changes (MACs) and potential roles of big data analytics (BDA) in accelerating the MACs in an Indonesian public hospital as a response towards the adoption of the diagnosis-related groups (DRG)-based payment system.

A mixed-method approach was used to collect and analyse data from a referral public hospital in Indonesia. First, a BDA simulation was carried out to reveal its usefulness in predicting and evaluating patient costs, and finally improving the cost recovery rate (CRR) of each DRG case. This part formulated and tested the mathematical models that predict patient cost, the CRR and determinants (length of stay/LOS, severity/SEV, patient age/AGE and gender/SEX). For this purpose, data of the top ten inpatient cases of 2018 were collected and analysed. Second, semi-structured interviews with senior staff and doctors were carried out to understand cost control strategies implemented in the hospital and the management and doctors’ perceptions regarding the application of tested mathematical models for cost control. Old institutional economics and new institutional sociology were used to gain insight about how and why management accounting practices changed in the hospital.

The findings show that the absence of detailed per-case/patient cost information has not only hindered further evolvement of MACs but also stimulate tensions between managerial and medical worlds in the studied Indonesian public hospital. The simulation of BDA in this study was not only discovering the determinants of case cost recovery but also enabling the prediction of CRR of patients immediately after admission. The application of BDA and casemix accounting in the hospital will potentially become catalysts of discussion and mutual learning between managerial and medical staff in controlling patient costs.

This paper provides a more comprehensive picture of the potential roles of BDA in cost control practices. The study assesses the feasibility of BDA application in the hospital and evaluates the potential roles and acceptance of BDA application by both management and doctors.